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illr�9r=+a <br />ATTACNMEt„ A <br />Page Iof7 <br />FOR DCA USE ONLY <br />Postmark date: <br />Date received: <br />Contract no: <br />Allocation amount: <br />Date approved: <br />FLORIDA FINANCIAL ASSISTANCE FOR COMMUNITY SERVICES ACT OF 1974 <br />FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS <br />COMMUNITY SERVICES TRUST FUND GRANT APPLICATION <br />See general instructions for information on how to properly complete this <br />application. THIS APPLICATION MUST BE POSTMARKED ON OR BEFORE AUGUST 1, <br />1987 TO BE CONSIDERED FOR FUNDING. <br />1. Local governmental unit applying for grant: <br />Name:Telephone: (305) non 567-AUt. 205 <br />(name of town. city or county <br />Address: 1840 25th Street <br />County: Indian River City: Vero Beach Zip: 3 960 <br />2. Person to be contacted by the Department of Community Affairs should <br />questions arise: <br />Name: Edwin M. Fry, Jr. Telephone: ( 309 567-860) Fxt 205 <br />Title: Chief Financial Officer <br />Address: 1840 25th Street , <br />Vero Beach, Florida Zip: 3296n <br />3. Name and address of person authorized to receive funds. If this <br />application is funded, checks will be mailed to this person. All <br />checks will be made payable to the local government. <br />Name: Edwin M. Fry, Jr. Telephone: (305) 567-2000 Ext. 7)5 <br />Address: 1840 25th Street <br />Vero Beach, I'lorida ZIP: 32.960 <br />4. Are there any delegate agencies covered in this application? <br />Yes X No <br />List below the name of each delegate agency included in this <br />application. <br />I. _Indian Rivar rnnnty r^ ;l oR A, ng, Inc. <br />2. Accnriatinn for v^*a,-,:e,, r'wweRs of Indian River County, Inc. <br />5. Name of person(s) authorized to sign quarterly financial reports: <br />(must agree with signatures on Attachment B) <br />Tndian Rivar r^„nt„ r^..n..;, an Aging, Inc. <br />Arlene S. Fletcher <br />